Laserfiche WebLink
Client a� � 5151 CE ZTi1 <br /> Calffornia SAMPLE CHAIN OF CUSTODY RECORD Address �- E�.x SCL, 57Z�E'TZ1N <br /> Water Labs (please print) Phone No. 4/4,</- e3-3-3 9.SZ0( <br /> % O 12Proj. Mgr./Contact ��� <br /> P.O. Box 4249 Ship samples to: Pink- Field Copy <br /> C Modesto, CA 95352 1430 Carpenter Lane White and Yellow-To Laboratory with Samples <br /> (209) 527.4050 Modesto, CA 95351 Record of Yellow-Return to Client <br /> PROJECT/SITE NAME: ANALYSIS REQUESTED <br /> L/ � FK/PD.J /�9D Sdui7/ Y.cA <br /> PROJECT/ ONTRACT/PON .: ." <br /> .ME OF M ER: l `(�} REMARKS/SPECIAL INSTRUCTIONS <br /> LAB 6SE ONLY SAMPLE a NUMBER <br /> LAB I.D. I.D. DATE TIME O CON- <br /> O O TAINERS <br /> /40,71t Z <br /> urq 2 <br /> z � - <br /> cN J l z <br /> fN � <br /> SFR i rH <br /> IN SHED Y SIG DATE/TIME RECEIVED BY SIGN DATE/TIME RECEIV D FOR LABORATORY <br /> J S BY(SIGN): m DATE(TIME T 3 : S <br /> v RECEIVED: 9 <br /> COLD AND INTACT OTHER PRESERVATIVE ❑YES�NO <br /> ❑OTHER: <br /> TURN AROUND TIME: <br /> SHIPPED VIA: ❑FED X ❑UPS ❑OTHER: SHIPPING ORDER NO.: E:124-Hr D2-Day \cy�Day 010-Day <br />